| NPI | 1700886876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA dc007212L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ mc05198) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2025-03-24 |